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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 13 - Pediatric heart transplantation

from Section 2 - Heart

Summary

This chapter discusses the physiological changes of brain death, the management of complex patients, the organization of the recovery, and new technologies that may allow increased number of organs available for transplantation. Most lethal brain injuries follow a common pathway whereby a patient suffers brainstem death secondary to sudden or gradual increases in intracranial pressure (ICP). Hemodynamic instability seen after brain death is also consequent to loading conditions imposed on the heart. The physiological changes of brain death have direct and indirect effects on lung function. Traumatic brain injury accounts for one third of all trauma related deaths. Early assessment of renal and liver quality is performed in cases of donor death secondary to trauma, exclusion of liver injury. It has been shown that treatment of ex vivo human lungs with an adenoviral vector encoding for interleukin (IL)-10 decreased inflammatory cytokine expression and led to significant improvements in graft function.

Further reading

CanterCE, ShaddyRE, BernsteinD, et al. Indications for heart transplantation in pediatric heart disease: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 115: 658–76.
KirkR, EdwardsLB, AuroraP, et al. Registry of the International Society for Heart and Lung Transplantation: Twelfth Official Pediatric Heart Transplantation Report-2009. J Heart Lung Transplant 2009; 28: 993–1006.
LamourJM, KanterKR, NaftelDC, et al. The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease. J Am Coll Cardiol 2009; 54: 160–5.
MangatJ, CarterC, RileyG, FooY, BurchM. The clinical utility of brain natriuretic peptide in paediatric left ventricular failure. Eur J Heart Fail 2009; 11: 48–52.
Pollock-BarZivSM, den HollanderN, NganBY, et al. Pediatric heart transplantation in human leukocyte antigen sensitized patients: evolving management and assessment of intermediate-term outcomes in a high-risk population. Circulation 2007; 116: I172–8.
WestLJ, Pollock-BarzivSM, DipchandAI, et al. ABO-incompatible heart transplantation in infants. N Engl J Med 2001; 344: 793–800.